2017 Emergency Department Coding and Reimbursement Update

The 2017 Medicare physician fee schedule was released on Nov. 2, 2016, with mostly good news for emergency medicine. As anticipated, there were minimal changes to the ED evaluation and management (E/M) codes, critical care, and observation service values in 2017. Table 52 of the final rule lists the estimated impact by specialty based on changes to the work, practice expense, and professional liability insurance relative value units (RVUs) for 2017. Most of the specialties listed, including emergency medicine, had an estimated impact of 0 percent in overall revenue being changed. There were a few winners, such as anesthesiology, family practice, internal medicine, and geriatrics, with a 1 percent increase, which is likely due to changes in the coordination of care codes for the primary care specialties. The losers in 2017 were gastroenterology, interventional radiology, and pathology, with 1 percent decreases; urology, with a 2 percent decrease; and independent lab, with a 5 percent decrease. Keep in mind that rounding can play a big role in whether you are plus or minus 1 percent or end up with an estimated zero change.

Conversion Factor Increases

Based on Protecting Access to Medicare Act of Half Percent Update The Medicare Access and CHIP Reauthorization Act (MACRA) mandated a 0.5 percent increase to the conversion factor for 2017. Several other factors also played a role with small negative adjustments. A negative budget neutrally adjustment factor impacted the 2017 conversion factor to offset overall increases in RVUs relative to 2016 as well as a target recapture update of -0.18 percent related to misvalued codes. The net impact is an increase of about $0.08 to the 2017 conversion factor, as shown in Table 50 from the final rule, with a published conversion factor of $35.8887.

Changes for Emergency Medicine in CPT 2017

There were no significant changes in the E/M code section and just the usual updating of the vaccine codes in the medicine section relating to tweaks to the composition or dosage information. For example, influenza codes will now be coded by dosage rather than age. The biggest change for emergency medicine is a new series of moderate (conscious) sedation codes.

The prior moderate (conscious) sedation codes (99143–99150) have been deleted and replaced with new codes (99151–99157). The new codes look similar in that there are three codes describing moderate sedation for both the scenarios where the sedation is provided in support of your own procedure and for another provider’s procedure. The three codes for each of these scenarios describe one code for patients younger than age 5, one for age 5 and older, and an add-on code for additional time providing moderate sedation.